Discovery medical aid

My husband is a member of Discover Medical Aid, Keycare plan for years and pay over R2700 a month for his medical aid. On Monday afternoon at four he started having pains in his left arm. these pains got worse and I realized that there was something big wrong with him. At that stage we were in Paarl

(I am not from the Cape and neither do I know the area). We tried to contact ambulances and they did not answer there phones. eventually after twenty minutes I realized that I had to do something and took my husband and traveled with him back to Stellenbosch where we stay and got him to the closest Medi-clinic so that he could get medical attention. at that stage he had two more attacks and was complaining that his mouth is dead and that he had difficulty talking.

He was immediately admitted at Mediclinic and was a code Orange/red and they confirmed that he had a few heart attacks. They treated him and stabilized my husband. the doctor who treated him then started looking for a hospital where they could transfer him to, due to the fact that they did not have a cardiac unit and he needs to be in ICU.

We were informed that all the hospitals which he could go to are full and that there was no beds available. He was then transferred by ambulance to the Vergelegen Mediclinic in Somerset where he could be monitored in ICU and get the proper treatment and care.

My husband spend three days in ICU and various tests was performed on him. It was found that the valve in his heart have to be replaced and that he would have to undergo a triple heartbypass as soon as possible. Due to the fact that the heart is weak after the attacks on Monday he was told by the Spesialist and surgeon to go home and be in bed rest until Sunday afternoon two o clock and then have to go back to the hospital where they would perform the operation that his life depends on Monday morning. This operation will be 8 hours long.

I have spoken to Discovery yesterday and they informed me that they are not going to pay for the medical bill for Monday for Stellenbosch Mediclinic due to the fact that it was not a emergency and I took him to the hospital. (the man had heart attacks!!!!! no ambulances were available and that was confirmed by the hospital that stabilized him. All Hearth ospitals in and around Stellenbosch were full and they did not have any place for a patient that have to go to ICU. I also inform the person that my husband will have to have the triple bypass and hear-valve replacement and he commented that he is not interested and that I have to speak to a case manager.

Discovery is prepared to pay for the treatment at Vergelegen Mediclinic due to the fact that he was suddenly a emergency because a ambulance took him to the clinic. so when you have a heart attack it is not an emergency but when you get treated for a heart attack it suddenly turn into a emergency. On the medical policy it indicates that in a life threatenening situation you can be admitted to a mediclinic to be stabilized and then they can transfer you to a hospital where keycare would be accepted.

My husband spoke to Discovery today to get a authorization number for the operation for Monday and was then informed that they are not going to pay for the operation in Vergelegen due to the fact that it is not an emergency. The girl who he spoke to also informed him that she will speak to her supervisor and that she only starts working at 14h00 tomorrow afternoon and will then return his call. This means that he cannot have the operation which he so badly needs.

She also informed my husband that if the Surgeon did not send him home that the Medical aid would have no problem to pay for the operation. Furthermore she also informed him that he will have to go to another hospital for the operation and that it cannot be done by the Surgeon who did the test and treated him for the past few days. That means that a new doctor will have to start all over with everything that was already done - medical aid have no problem paying for him instead of the person that have treated my husband and knows exactly what has to be done.

Discovery is seen as been one of the best medical aids as long as you pay your membership. On paper they are full of promises but in reality - their internal politics does not make sense and could cost a patient's life!!!!!

I need to know from somebody who can answer my questions, 1. what are they going to do if my husband have another heart attack? are they going to wash their hands and say sorry? I 2. do not think so because they will directly be responsible due to the fact that he could not have the surgery he so badly needed. although he is covered by his medical aid. That would be negligence. 3. What is going to happen next? 4. How can you treat a cardiac arrest the one moment as a code orange/red and inform the patent that it was not an emergency and then turn around and say it is a emergency. the diagnose is still cardiac arrest and have never change. 5. Need someone who has authority and not a person in a call-centre who does not know and cannot make decisions.

This posting is also not to start a debate but I am desperately seeking for answers for Discovery directly and not agents

I would appreciate it if someone can contact me or I will go viral with this post and hold them personally responsible if anything will happen to my husband. Me and my husband are very traumatized since Monday and now with Discovery"s attitude things have worsen completely. My husband was prepped for the operation and positive mentally and now we are sitting with worries and unnesessary stress created by our Medical Aid.